Department of Surgery, Section of Otolaryngology- Head and Neck Surgery, Cumming School of Medicine, University of Calgary, HRIC 2A02 3280 Hospital Dr NW, Calgary, Alberta, T2N 4Z6, Canada.
Ohlson Research Initiative, Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
J Otolaryngol Head Neck Surg. 2021 Apr 23;50(1):28. doi: 10.1186/s40463-021-00508-y.
Physician opioid-prescribing patterns have significant impacts on the current opioid crisis. Patients who use opioids in the postoperative period are at risk of developing chronic postoperative opioid use. This study determined the rate of chronic postoperative opioid use among head and neck cancer patients undergoing primary surgery with free-flap reconstruction. Additionally, this study identified major risk factors associated with the development of chronic postoperative opioid use.
A retrospective chart review was performed for all adults (age ≥ 18 years) undergoing primary head and neck surgical resection with free-flap reconstruction between January 2008 and December 2015. Patients were identified from a prospectively collected database, Otobase™. Data from the provincial drug insurance program were used to capture drug dispensing information to determine chronic opioid use at 3- and 12-months postoperatively. Data extracted from Otobase™ included patient demographics, social habits, clinical stage, pathological stage, type of surgery, and adjuvant treatment.
The total cohort was comprised of 212 patients. Chronic opioid use at 3- and 12- months postoperatively was observed in 136 (64%) and 116 (55%) patients, respectively. Of the 212 patients, 85 patients (40%) were identified as preoperative opioid users and 127 were opioid naïve (60%). Of the 85 patients who were preoperative opioid users, 70 (82%) and 63 (77%) patients continued to use opioids 3- and 12-months postoperatively, respectively. The proportion of opioid-naïve patients who were using opioids at 3- and 12-months postoperatively was 52% (66 patients) and 42% (53 patients), respectively. Identified risk factors included preoperative opioid use, prior tobacco use, advanced pathologic T-stage, and adjuvant treatment.
Among head and neck cancer patients that have undergone major resection with free-flap reconstruction, the prevalence of chronic postoperative opioid users was considerable. Identified risk factors included preoperative opioid use, prior tobacco use, tumor stage, and adjuvant treatment.
医生开具阿片类药物的模式对当前阿片类药物危机有重大影响。术后使用阿片类药物的患者有发展为慢性术后阿片类药物使用的风险。本研究旨在确定接受游离皮瓣重建的头颈部癌症患者行原发性手术后慢性术后阿片类药物使用的发生率。此外，本研究还确定了与慢性术后阿片类药物使用发展相关的主要危险因素。
对 2008 年 1 月至 2015 年 12 月期间接受游离皮瓣重建的原发性头颈部手术的所有成人（年龄≥18 岁）进行回顾性图表审查。患者是从一个前瞻性收集的数据库（Otobase™）中确定的。利用省级药物保险计划的数据来获取药物配给信息，以确定术后 3 个月和 12 个月的慢性阿片类药物使用情况。从 Otobase™ 中提取的数据包括患者人口统计学资料、社会习惯、临床分期、病理分期、手术类型和辅助治疗。
总队列包括 212 例患者。术后 3 个月和 12 个月时慢性阿片类药物使用者分别为 136 例（64%）和 116 例（55%）。在 212 例患者中，85 例（40%）为术前阿片类药物使用者，127 例为阿片类药物初治者（60%）。在 85 例术前阿片类药物使用者中，分别有 70 例（82%）和 63 例（77%）患者在术后 3 个月和 12 个月继续使用阿片类药物。术后 3 个月和 12 个月时，未使用过阿片类药物的患者中分别有 66 例（52%）和 53 例（42%）使用阿片类药物。确定的危险因素包括术前阿片类药物使用、既往吸烟史、晚期病理 T 分期和辅助治疗。
在接受游离皮瓣重建的头颈部癌症患者中，慢性术后阿片类药物使用者的比例相当高。确定的危险因素包括术前阿片类药物使用、既往吸烟史、肿瘤分期和辅助治疗。
